NPIMap

Individual provider Active NPI

Kennon D Wigley, MD

  • Cardiovascular Disease Physician
  • Bryan, TX
National Provider Identifier
1215904495
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
G5771 Issued in TX
Practice address
2700 E 29TH Street
Suite 220
Bryan, TX 77802
Phone
(979) 774-4008
Fax
(979) 774-7893
NPI assigned
Mar 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X G5771 TX Primary

Addresses

Primary practice location

2700 E 29TH Street
Suite 220
Bryan, TX 77802

Mailing address

2700 E 29TH Street
Suite 220
Bryan, TX 77802
Phone (979) 774-4008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101116001008 TX Practitioner - Cardiovascular Disease (Cardiology) 8426243403 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Texas Medical School at Houston, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Texas Heart CenterGroup PAC ID 6901880863, 10 clinicians

Practice addresses (Care Compare)

2700 E 29TH St
Suite 220
Bryan, TX 77802-2586
Phone (409) 774-4008

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Regional Health Center CurrentSince Jan 2, 2022 Accepting new patients

Locations

2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1215904495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 E 29TH STREET",
            "address_2": "SUITE 220",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "77802",
            "telephone_number": "979-774-4008",
            "fax_number": "979-774-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 E 29TH STREET",
            "address_2": "SUITE 220",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "77802",
            "telephone_number": "979-774-4008",
            "fax_number": "979-774-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGLEY",
        "first_name": "KENNON",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "G5771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.